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Jefferson's Burst Fracture treated with Posterior C1 Lateral Mass Screw Approximation

Three Part Question

if [one level
fracture repair fixation] be performed on [Jefferson’s fractures without complications, and with a
reasonable clinical outcome]are better than [conservative management of the fracture]?

Clinical Scenario

A 20-Year-old female front seat passenger with the seat belt on sustained a neck injury from a frontal collision car Accident that left her with a fronto-parietal scalp laceration; presented to the Emergency Room with cervical spine precautions. Primary survey demonstrated a non-disabling local neck pain and tenderness. The neurologic examination was normal with no disabilities, and no cranial nerve involvement. Glasgow coma scale was 15/15. Past medical history is unremarkable with no previous incident.

An X-Ray, Computed Tomography (CT) scan and MRI of the neck revealed only a Jefferson fracture with a 12 mm widening of the lateral mass of C1. The Anterior Atlanto-Dens Interval (ADI) was normal (2mm) and the Space Available for the Cord was 17mm.

Search Strategy

A National Library of Medicine (PubMed), OVID, Cochrane Library, and google scholar computerized literature search from 1984 to 2019 was undertaken using Medical Subject Headings in combination with “Jefferson’s fracture”, “Lateral Mass”, “atlas” and “human”.
This search strategy yielded more than 30 references. The abstracts were reviewed, and articles addressing clinical management and follow-up of atlas fractures were selected for inclusion. The relative infrequency of these fractures, the small number of case series, and numerous case reports with pertinent information required rather broad inclusion and exclusion criteria. The bibliographies of selected articles were reviewed to provide additional references and to assess the completeness of the literature review.

Search Outcome

When comparing surgical intervention with halo-vest immobilization(HVI), surgical reduction with fixation reduces fractured lateral mass displacements, increases fusion rate, and reduces time-to-fusion while maintaining cervical curvature and improving neck pain and daily activities.